Form Mt-203-Att - Information On Roll-Your-Own Cigarette Tobacco Manufactured Or Imported By A Distributor
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2MT-203-ATT
New York State Department of Taxation and Finance
Information on Roll-Your-Own
(5/10)
Cigarette Tobacco Manufactured or
Imported by a Distributor
Read instructions (on back) carefully before completing. Keep a copy of this completed form for your records.
Legal name (corporation, partnership, or individual name)
Federal employer identification number (EIN) or
Month/year of this report
social security number (SSN)
(mm-yyyy)
Address (number and street or PO box)
City
State
ZIP code
Phone number
(
)
No reportable activity for the month
...............................................................................................................................
(see instructions)
A
B
C
D
Quantity of roll-your-
Name, address, and EIN of supplier
Name, address, and EIN of
Brand name(s) of
own cigarette tobacco
tobacco
manufacturer
manufactured or
imported by your
business
(enter amount
in pounds)
1 Total quantity of roll-your-own cigarette tobacco manufactured or imported by your
business
................................................................................................................
1
(enter amount in pounds)
Attach additional sheets if necessary.
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